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Treatment Options

Obesity treatment may involve surgical or non-surgical methods.

Non-Surgical Treatment

The three major phases of any successful weight-loss program are:

Like all chronic medical conditions, effective management of obesity must be based on a partnership between a highly motivated patient and a committed team of health professionals, including the physician, psychologists, physical and exercise therapists, dieticians, and other sub specialists, depending on the co morbidities of the individual patient. However, they show short-term success, and for the morbidly obese, the results rarely last. For many, this can translate into what's called the "syndrome" in which the patients continually gain and lose weight with the possibility of serious psychological and health consequences.

When it comes to permanent weight loss, recent research reveals that conventional methods of weight loss generally fail. Patients on diet, exercise programs or medication lose about 10% of their body weight but tend to gain two-thirds of it in one year and almost all of it within five years. Another study found that patients in weight loss programs who were able to maintain their reduced weight after five years are less than 5%. People generally regain two thirds of the weight lost within a year, and they regain almost all of it within 5 years. If you are tired of trying all treatments without much success, you might explore the surgical option. It is the only proven method of achieving long-term weight control and also regress co-morbid conditions effectively.

  • A pre-inclusion screening phase involving identification of BMI, evaluation of co-morbidities like hormone deficiencies, metabolic syndromes and other diseases.
  • A definitive weight-loss program includes diet, exercise, life style changes and;
  • A maintenance phase, which can conceivably last for the rest of the subject's life but which must last for at least 2 years after the weight-loss program is completed.

Nutrition

Non-surgical treatment majorly involves nutritional counseling with or without usage of supplements to enhance the weight loss program. Management by nutrition and supplements being the pillars of weight loss and is highly individualistic. A reasonable goal for weight-loss in the setting of a nutrition based treatment program is approximately 1.0 -1.5 kg/wk. The concept that the weight-loss goal for each subject must be individualized and cannot be unilaterally based on standard weight-for-height diet norms is becoming increasingly apparent. One must consider the family's weight, as well as the patient's weight and cultural, ethnic, and racial background in setting individualized nutritional goals of weight loss. Consider these suggestions, and think about what other small changes might work for you.

  • Cut out the liquid calories, especially soda. This is important. Most calorie laden drinks are high in sugar. Your fruit juice might have a lot of vitamin C but it probably lacks fiber. Slowly eliminate sodas, juices, energy drinks, and other calorie filled liquids. They aren't very satisfying and will only keep you heavier. Replace liquid calories with water, water flavored with ginger/lemon, or herbal tea.
  • Eat only whole foods. Throw out the white bread, white rice, white sugar, and refined sugary cereals. Get rid of canned soups and concentrate on wholesome ingredients.
  • Don't think about counting calories.

Start using healthy alternative sweeteners

Lifestyle Changes

The best way to start your weight loss program is to understand where you are going wrong in your lifestyle activity and alter it so that you start working towards weight loss the right way. Mere starving in the name of diet and gym will not help in long run. They might give you an initial satisfactory weight loss, but after few months you tend to lose energy and become weak rather than losing weight. You really need to be smart to work on your lifestyle and lose weight without much hard work.

The first and foremost change is to become more mobile. If you move around enough, you can reduce the risk of all lifestyle diseases and burn up to 500 calories per day without even dieting or hitting the gym. It requires you to rethink all your habits and find new, more active ways to get through the day. Other major issue is the timing of meals. Our body will have the least calorie-spending rate between 8 pm and 6 am. Also there will not be much of activity after you meal late in the night, which will not allow you to spend the calories taken in. If you can regularize your meals to the time when your body is at its peak metabolism potential, ie 7 am, 12 pm, 7 pm, you will burn up to 500 calories more than before without even moving a muscle. You will be surprised to hear even sleeping early can help you stay slim. The above lifestyle changes can add up to burning of 1500 calories along with an insensible loss of 500 calories, which accounts for the expenditure of almost all the calorie intake in a healthy Indian diet. This is simply how you go from being couch potatoes to muffin-top blasting fitness freaks.

Exercise

When it comes to successful and lasting weight loss, eating well is only part of the battle. Physical activity will help you inch closer to your goal by burning calories and building muscle. However, that's not the only reason to make exercise part of your daily life. Exercise also helps prevent many health conditions, decreases stress, and makes you feel better. The Centers for Disease Control and Prevention (CDC) encourages healthy adults to complete at least two hours and 30 minutes of moderate aerobic activity per week. Moderate aerobic activity includes many forms of exercise, such as brisk walking, using an elliptical machine, or swimming laps. Alternately, you can complete one hour and 15 minutes of vigorous aerobic activity per week, such as running or cycling.

It's best to spread your exercise out throughout the week. Aim to get 30 to 60 minutes of aerobic activity on most days. The CDC also recommends doing strength training, such as weightlifting or yoga, at least twice per week.

One excellent, widely available option is walking. You also have other options besides walking. Just make sure to start slowly and gradually build up your fitness level. Beginning an exercise program too quickly is a recipe for injury and could set you up for failure. The more you exercise, the less you need to reduce your food intake. By increasing your muscle mass, you increase your metabolism. When you replace fat with muscle, your body burns more calories at rest. In general, people who exercise regularly are healthier and get sick less often. Regular workouts can help you prevent and manage many health problems, including:

  • high blood pressure
  • high cholesterol
  • cancer, including colon and breast cancer
  • type 2 diabetes
  • rheumatoid arthritis

Surgical Treatment

Weight-loss surgery has proven to be a successful method for the treatment of morbid obesity. Due to the continuous evolution of surgical principles, today there are multiple options that enable both patients and surgeons to choose the procedure of choice according to their convenience. Some of the surgical procedures performed to treat obesity include:

  • Intragastric balloon
  • Gastric banding
  • Sleeve gastrectomy
  • Roux en Y gastric bypass
  • Mini Gastric Bypass
  • Other novel procedures
  • Cosmetic procedures such as liposuction, and tummy tuck

The use of laparoscopy for performing these procedures is the biggest advancement in bariatric surgery. The laparoscopic procedure is a minimally invasive procedure where the surgery is performed through small incisions. Patients experience minimal discomfort and rapid recovery with the process.

Indications

According to international accepted criteria, the indications for obesity surgery are

  • BMI > 40 kg/m2
  • BMI>35 with pronounced co-morbidities.
  • Failed non-surgical attempts at weight reduction over a period of one year
  • Absence of surgical contraindication or concomitant disease.
  • Age between 18 and 65 years

With the change in the geographic nature of obesity based on food, lifestyle and genetic make-up of patients, modification to international accepted criteria were made by IFSO-APC, IDF & OSSI by way of reducing the BMI by 2.5 points. Nevertheless, limits to the indication for surgery continue to be changing. For example, diabetes specialist suggests a BMI of 32 kg/m2 in patients with type 2 diabetes as an indication for surgery. The general exclusion criteria involve organ-related cause of obesity (endocrine disease), severe mental disorder (schizophrenia, florid drug addiction or severe depression), severe concomitant disease (cancers), patients under 18 or over 65 years of age, and a high surgical risk (relative contraindication). With introduction of a recent criteria, adolescent population with high risk for normal life due to obesity can be taken as an criteria for surgical indication.

Contraindications

Bariatric surgery is not recommended in patients with:

  • Inflammatory diseases such as Crohn's disease
  • Severe heart, lung or liver diseases
  • History of auto immune diseases such as scleroderma or systemic lupus erythematous
  • Alcohol or drug addiction
  • Under the age of 18 years
  • Pregnancy
  • Chronic pancreatitis (inflammation of the pancreas)
  • Presence of Infection.